You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.
Position Purpose: Responsible for the timely, consistent, and accurate communication of state and federal regulatory updates related to the filing of commercial plans. Prepares, organizes, and submits the annual QHP and Off-Exchange product filings for assigned states using Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF). Acts as the primary contact between Regulators and the company, supporting communication during the filing season.
- Monitors for updated regulatory guidance and requirements affecting Centene’s commercial products. Identifies, analyzes, interprets, summarizes and distributes regulatory filing guidance and requirements related to Centene’s commercial products out to impacted departments. Assists partners with understanding of filing requirements and timelines. Anticipates and proactively communicates risks associated with filing updates due to regulatory changes.
- Executes timely and accurate formal regulatory filings, including the annual QHP and off-exchange product filings, seeking approval of our commercial health products within Health Insurance Oversight System (HIOS) and System for Electronic Rates & Forms Filing (SERFF) for assigned states and tracks deliverables across multiple departments. Is a subject matter expert on yearly filing requirements.
- Acts as the primary contact between Regulators and the company, supporting communication during the filing season as needed. Manages relationship with regulatory agencies (Department of Insurance and Centers for Medicare & Medicaid Services (CMS)) and communicates directly to regulators on behalf of internal. Reviews objection responses, analyzing for risk, and communicates risks out to the business. Provides direction and guidance on mitigating risk within responses.
- Performs research and interpretation of regulatory filing rules and regulations to aid in the development of products and initiatives for the Enterprise related to commercial products. Creates visual tools to assist in communicating complicated ideas to larger audiences.
- Interprets and distributes data collected throughout the filing season to aid in proactively updating processes for ongoing improvement across multiple departments. Presents data to internal stakeholders to be used in decision making.
- Responsibility for understanding regulations and business needs for multiple states, as well as federal regulations pertaining to the commercial health insurance market.
- Creates and maintains a deliverables chart which outlines all required documents needed for state specific filings. Develops and maintains multiple critical trackers related to filing work to monitor submissions, including building a repository of previously received objections to decrease YOY objection totals. Audits trackers and deliverable for assigned states to ensure consistency and quality across teams. Assist junior staff in year over year updates as needed to trackers.
- Assesses regulator objections and provides guidance to cross-functional partners for the purpose of crafting appropriate responses for regulators.
- Develops trust-based relationships and collaborates with other functional areas to lead projects and initiatives. Serves as a Subject Matter Expert. Leads sub-projects and large initiatives. Leads assigned special projects and maintains multiple trackers. Should have the ability to understand the needs of internal and cross-functional departments and communicate those needs effectively at the appropriate level of detail for the audience and present complicated ideas to leadership.
- Maintains and implements department policies, procedures, and work processes. Assists in developing junior employees and maintain/update training materials.
- Identifies, analyzes, and manages resolution of filing related issues for high risk states.
- May attend external and/or virtual conferences and seminars to evaluate industry trends.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
- Bachelor's Degree Business, Communications, Healthcare, Political Science, related field or equivalent experience required.
- 4+ years regulatory experience, including policy analysis and/ or product filings (CMS and/ or State DOI) or other related experience required.
- In depth knowledge of health products, procedures, and state insurance regulations preferred.
- Experience in commercial health insurance preferred.
- Knowledge of SERFF and HIOS strongly preferred.
Pay Range: $67,400.00 - $121,300.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
